Effectively managing patients with chronic disorders requires balancing their treatment with the compensatory mechanisms of the body. A deviation from a prescribed course of treatment, such as continuing to smoke or drink alcohol when instructed otherwise by a caregiver, could result in a downward health trend. Non-compliance with medication or dietary restrictions is the leading preventable cause of acute coronary decompensation. A. Michalsen et al., Preventable Causative Factors Leading To Hospital Admission With Decompensated Heart Failure, 80 HEART 437-441 (1998), and S. J. Bennett et al., Characterization of the Precipitants of Hospitalization for Heart Failure Decompensation, 7 AM. J. OF CRIT. CARE 3:168-174 (May 1998), the disclosures of which are incorporated by reference. Consequently, patient management requires continually evaluating both clinical trajectory and patient compliance.
Caregivers play an active role in patient management by periodically seeing patients in-clinic for diagnosis and follow-up. When intervention is required, caregivers generally will prescribe a course of treatment that can include medication, dietary restrictions, lifestyle changes, and other directions, such as described in M. H. L. van der Wall et al., Compliance And Heart Failure Patients: The Importance Of Knowledge And Beliefs, 27 EURO. HEART J. 434-440 (2006), the disclosure of which is incorporated by reference. Additionally, as an aid in managing patients, caregivers are increasingly relying upon physiometry obtained through remote monitoring, particularly when in-clinic follow-up is infrequent or impracticable. For example, patient-operable interrogators, commonly known as “repeaters” or “communicators,” enable caregivers to remotely gather hemodynamic data and general patient physiometry for managing CHF. Changes in patient condition detected through monitoring that might indicate a need for further intervention are thereby identified sooner than would otherwise be possible, absent remote patient management.
Nevertheless, managing a chronic disorder through remote at-home monitoring lacks the interpersonal dynamic of an in-clinic visit. The patient uses a remote communicator that periodically interrogates any implantable or external medical devices. Recorded data is thereafter uploaded for caregiver review and evaluation. Qualitative “soft” data can be collected through the communicator or other device through interactive questioning regarding a patient's perceived health and well-being. Although questions can be tailored to a particular patient's circumstances, the inquiry remains divorced from factors indicating possible patient non-compliance or emotional imbalance, such as abnormal physiometry.
U.S. Pat. No. 6,168,563, to Brown, discloses a system and method that enables a healthcare provider to monitor and manage a health condition. A clearinghouse computer communicates with a patient through a data management unit that monitors the patient's health. Physiological monitoring devices, such as a blood glucose monitor or peak-flow meter, may also supply patient information. Healthcare professionals can access the patient information through the clearinghouse computer, which can process, analyze, print, and display the data. Although the patient queries can address specific healthcare concerns, Brown fails to corroborate the monitored information with patient compliance.
U.S. Pat. No. 6,263,245 issued Jul. 17, 2001, to Snell, describes a portable system and method for conducting wireless interrogation of an implantable medical device (IMD). A portable interrogation device can be directly interfaced with a data processing device, such as a programmer/analyzer. The device includes a control circuit for controlling transmission, a transmitter, a receiver for receiving IMD interrogation signals, memory for storing data, and an electronic communications interface for delivering to the data processing device. However, the device only facilitates relay of data without analysis or processing and fails to corroborate the interrogated data with patient compliance.
Therefore, there is a need for an approach to tying the remote monitoring of patients, particularly those patients who are suffering from a chronic disorder, to patient compliance to a prescribed course of treatment and recognition of potential emotional imbalance. Preferably, such an approach would link the emotional state observed to physiometry measured at about the same time.